Short-term outcomes of laparoscopic extended hepatectomy versus major hepatectomy: a single-center experience.

INTRODUCTION: Laparoscopic major hepatectomy (LMH) remains restricted to a few specialized centers and poses a challenge to surgeons performing laparoscopic resections. Laparoscopic extended resections are even more complex and rarely conducted. METHODS: From a single-institution database, we compared the short-term outcomes of patients who underwent major and extended laparoscopic resections, stratifying the entire retrospective cohort into four groups: right hepatectomy, left hepatectomy, right extended hepatectomy, and left extended hepatectomy. Patient demographics, tumor characteristics, operative variables, and especially postoperative outcomes were evaluated. RESULTS: 250 patients underwent major and extended laparoscopic liver resections, including 160 right, 31 right extended, 36 left, and 23 left extended laparoscopic hepatectomies. The most common indication for resection was colorectal liver metastases (64%). Laparoscopic extended hepatectomy (LEH) showed significantly longer operative time, more blood loss, need for Pringle maneuver, conversion to open surgery, higher rates of liver failure, postoperative ascites, and intra-abdominal hemorrhage, R1 margins and length of stay when compared with the LMH group. Mortality rates were similar between groups. Multivariate analysis revealed intraoperative blood transfusion (OR = 5.1[CI-95%: 1.15-6.79]; p = 0.02) as an independent predictor for major complications. CONCLUSIONS: LEH showed to be feasible, however with higher blood loss and significantly associated to major complications.

Analysis of cathepsin S expression in gastric adenocarcinoma and in Helicobacter pylori infection.

BACKGROUND: Recent experimental studies have suggested a potential link between cathepsin S (CTTS) and gastric adenocarcinoma progression. Herein, we aimed to evaluate the expression of CTTS in gastric adenocarcinoma in patients who underwent curative-intent surgical resection. METHODS: This was a cross-sectional study that included two groups: gastric adenocarcinoma (n = 42) and gastritis (n = 50). The gastritis group was then subdivided into H. pylori-positive (n = 25) and H. pylori-negative (n = 25) groups. Gastric tissue samples were analysed to determine CTTS expression through immunohistochemistry. Samples were obtained by oesophagogastroduodenoscopy or surgical specimens. RESULTS: In patients with gastritis, the age ranged from 18 to 78 years. Among them, 34% were male, and 66% were female. In patients with gastric adenocarcinoma, the age ranged from 37 to 85 years. Among them, 50% were male. When comparing the expression of CTTS between the two groups, only 16% of the gastritis samples had an expression higher than 25%. Alternatively, among patients with gastric adenocarcinoma, 19% had expression between 25-50%, 14.3% between 51-75%, and 26.2% had expression higher than 75% (p < 0.001). In the gastritis group, CTTS expression was significantly higher in patients with a positive test for H. pylori than negative test for H. pylori: 87.5% and 38.5%, respectively (p<0.001). There was no statistically significant association between CTTS positivity and clinicopathological variables, including tumour staging, histological type, angiolymphatic invasion, recurrence, current status and death. CONCLUSION: CTTS expression is higher in gastric adenocarcinoma samples. Patients with gastritis due to H. pylori also show a higher expression of CTTS than patients with negative results for this bacterium.

Rare Mixed Adenoneuroendocrine Carcinoma of the Gallbladder: Case Report and Review of Literature.

BACKGROUND Mixed adenoneuroendocrine carcinoma of the gallbladder (gMANEC) is an extremely rare cancer. Most of the cases are reported in Asia, North America, and Europe, with no cases reported in Latin America; this is the first report for this region, and the 24th case reported worldwide. CASE REPORT A 68-year-old woman was referred to our department due to asthenia and moderate abdominal pain in the right upper quadrant for 6 months, with imaging examinations showing a solid heterogeneous expansive lesion in gallbladder topography and segment IV of the liver. The MRI displayed an expansive and heterogeneous lesion with inaccurate limits in the gallbladder affecting segment IVb of the liver, in addition to lymphadenopathy in the hepatic hilum. A cholecystectomy with resection of segments IV-B and V of the liver (radical cholecystectomy) and hepatic hilar lymphadenectomy were performed. Anatomopathological examination and immunohistochemistry confirmed a primary mixed adenoneuroendocrine carcinoma of the gallbladder. The patient received adjuvant chemotherapy and radiotherapy; however, after the patient reported experiencing low back pain, a CT was performed, revealing retroperitoneal metastasis, and the radiotherapy was interrupted. Currently, the patient has a stable disease, following a protocol of 5-Fluorouracil and somatostatin, and she reports having low back pain of low intensity. CONCLUSIONS This is the 24th gMANEC case reported in the literature. The tumor was successfully resected; however, the patient presented retroperitoneal metastasis 6 months after surgery, despite combined adjuvant therapy.

Primary hepatic neuroendocrine tumor: A case report and literature review.

INTRODUCTION: Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare, having less than 200 cases reported in the literature. PRESENTATION OF CASE: A 51-year-old woman presenting with mild intensity sharp pain in the upper abdomen that started 4 years ago. Preoperative Magnetic Resonance Imaging (MRI) suggested hepatocellular adenoma. Surgical exploration found a tumor occupying the whole segment IV of the liver, therefore a left hepatectomy was performed. Pathology and immunohistochemistry indicated to be a low-grade neuroendocrine tumor of the liver. The patient is enjoying a good quality of life, free of disease, presenting no signs of recurrence nor metastases 12 months after the procedure. CONCLUSION: The clinical presentation of PHNETs is non-specific and its radiologic features are intensely diversified, frequently leading to misdiagnosis of other hepatic neoplasms.

Surgical resection of pancreatic insulinoma during pregnancy: Case report and literature review.

INTRODUCTION: Insulinomas are neuroendocrine tumors characterized by an excessive secretion of insulin, and its most common primary site is the pancreas. PRESENTATION OF THE CASE: Female, 31 years old, who underwent surgical resection of a pancreatic insulinoma measuring 0.5 × 0.5 cm during the third trimester of pregnancy. The patient started to present characteristic symptoms (hypoglycemia, adrenergic and neuroglycopenic symptoms) 18 months before being referred to our center. It was decided to resect the lesion due to the intensity of the symptoms and failure of the clinical treatment. The postoperative course was uneventful, and the fetus presented good vitality, as evidenced by the obstetric ultrasound. The patient was discharged from the hospital on the 6th postoperative day. The neonate was born at term, 38 weeks, with appropriate weight for gestational age. Today, around 12 months after surgery, the patient and the infant are in good health conditions and have no complaints. CONCLUSION: The moment of the surgical intervention in our case reflects the importance of this report, since it reinforces the feasibility of this procedure during pregnancy.

Weight and morphometric growth of Pacu (Piaractus mesopotamicus), Tambaqui (Colossoma macropumum) and their hybrids from spring to winter / Peso e crescimento morfométrico de pacu (Piaractus mesopotamicus), tambaqui (Colossoma macropumum) e seus híbridos da primavera ao inverno

This study aimed to evaluate weight and morphometric growth of the products of the complete diallel cross-breeding between pacu and tambaqui during the period from the end of spring to the beginning of winter. Was used 400 pacu, tambaqui, tambacu and paqui. 20 fish from each group were collected, weighed and submitted to morphometric evaluation every 28 days. The Logistic function adjusted better to describe the growth in body weight and the morphometric measures for age on all the genetic groups. The studied groups presented similar behavior of growth for body weight and morphometric measures. There were significant differences between the genetic groups regarding parameters A (asymptotic value) and B (integration constant) for body weight and for all the morphometric measures evaluated. For the parameter K (maturity rate), there were significant difference between groups for body weight, head length and body height. The groups possibly were affected the decrease of temperature. The Tambacu was superior to the Paqui in all the variables evaluated for the parameter A, and was also superior to the pure breed, except for head length and body width.(AU)

Este estudo teve como objetivo avaliar o peso e crescimento morfométrico dos produtos do cruzamento dialélico completo entre pacu e tambaqui. 20 peixes de cada grupo foram coletados, pesados e submetidos à análise morfométrica a cada 28 dias. O modelo que obteve o maior coeficiente de determinação e que melhor se ajuste ao método de Akaike foi verificado. A função logística foi ajustada para melhor descrever o crescimento do peso corporal e as medidas morfométricas para a idade em todos os grupos genéticos. Os quatro grupos estudados apresentaram comportamento semelhante para o peso corporal, bem como para as medidas morfométricas. Houve diferenças significativas entre os grupos genéticos sobre os parâmetros A (valor assintótico) e B (constante de integração) para o peso corporal e para todas as medidas morfométricas avaliadas. Para o parâmetro K (taxa de maturação), houve diferença significativa entre os grupos para o peso corporal, comprimento da cabeça e altura do corpo. Os grupos possivelmente foram afetados pela diminuição da temperatura. O tambacu foi superior ao Paqui em todas as variáveis avaliadas para o parâmetro A, e também foi superior para a raça pura, exceto para o comprimento e largura do corpo de cabeça.(AU)

Inclusion of Yucca schidigera extract in diets with different protein levels for dogs.

This study evaluated the effects of inclusion of Yucca schidigera extract (YSE) in two diets with different levels of crude protein (CP) for dogs on facal odour, nutrient digestibility, ammonia concentration in feces and hematological and serum biochemical profiles. Twenty adults Beagles were used, distributed in a randomized block design in a 2 × 4 factorial design (two diets, 25% and 34% CP, and four YSE levels: 0, 250, 500 and 750 mg/kg) with five replicates, obtained during two experimental periods. The fecal odour reduced (P < 0.05) when 500 mg/kg of YSE was used in diets with higher CP. The inclusion of YSE reduced (P < 0.05) fecal ammonia, and the inclusion of 250 and 500 mg/kg YSE reduced intestinal gas. The inclusion of 750 mg/kg YSE increased the mean corpuscular hemoglobin (MCH), alanine aminotransferase (ALT) activity and tended to increase the serum cholesterol concentration, regardless of the protein level of the diets. There was no effect on the digestibility of nutrients, fecal consistency, nitrogen balance and thickness of the intestinal wall. The inclusion of 500 mg/kg YSE is effective in reducing fecal odour in dogs receiving diets with 34% of CP. Regardless of the protein content, YSE reduces fecal ammonia, but may cause adverse effects if included at higher doses.

Acidifying and yeast extract in diets for adults cats.

This study evaluated the effects of adding an acidifying agent based on phosphoric acid (A), a yeast extract from a specific strain (Saccharomyces cerevisiae) (Y) and the combination of these two additives in food for adult cats. A test was conducted with 24 animals (mean 3.5 years old), mixed breed, weighing 3.72 ± 0.74 kg, kept in individual metabolic cages and distributed in a completely randomized design with a 2 × 2 factorial design (with or without A 0.6% of dry matter, with or without Y 1.5% of dry matter) totalling four treatments and six replicates of each condition. The experimental period was 15 days. The A or the Y reduced (P< 0.01) the dry matter intake, but the effect was not observed when they were associated. The association improved (P<0.05) the digestibility of dry matter and ashes. The A reduced urine pH (P=0.05) regardless of the presence of the Y. There was no effect (P>0.09) on other parameters evaluated. Results of this study show that the isolated use of 0.6% A or 1.5% Y in diets for cats is not recommended. However, the association of these two additives was beneficial in increasing nutrient digestibility.